Volume 104 · Issue 06 · 2024

Basal cell carcinoma (BCC) is the most common skin malignancy, with a higher prevalence in Caucasians than in East Asians. Although there is a lack of epidemiological data in China, it is generally believed that the incidence of BCC in China is increasing due to the aging population. A variety of risk factors are related to the occurrence of BCC, among which ultraviolet rays and gene mutations play a major role, especially the abnormal activation of Hedgehog (Hh) signaling pathway, which is considered to be the most important pathogenesis of BCC. The clinical manifestations of BCC are highly specific, and most experienced doctors can make a preliminary diagnosis by clinical manifestations. Dermoscopy and other imaging methods can greatly improve the accuracy of diagnosis, but there are still some atypical or rare types of BCC that need further confirmation through histopathological examination. This guideline is initiated by the National Clinical Research Center for Skin and Immune Diseases (based on Peking University First Hospital). It has invited a panel of experts consisting of 24 senior dermatologists specializing in dermatologic surgery from the Dermatologic Surgery Group of the Chinese Medical Doctor Association of Dermatology, the Dermatologic Surgery Group of the Dermatology & Venereology Committee, Chinese Association of Integration Medicine, and the Dermatologic Surgery and Cosmetic Branch of Clina Leprosy Association. In addition, experts from the Burn and Plastic Surgery (Maxillofacial), Ophthalmology, Otolaryngology, Head and Neck Surgery, Radiation Therapy, and Pathology were also invited to participate. This panel forms the "Chinese Guideline for the Diagnosis and Treatment of Basal Cell Carcinoma" expert group. Based on the latest domestic and international research findings, the guideline was developed through four rounds of discussions by the expert group and revised to provide valuable references for clinical healthcare providers in the diagnosis and treatment of BCC.

Immunotherapy has become the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) with negative driver genes, which has significantly improved the prognosis of patients. However, there is still a lack of consistent guidelines or consensus on evaluation and treatment regimens after first-line immunotherapy resistance. The Committee of Non-Small Cell Lung Cancer of Chinese Society of Clinical Oncology organized multidisciplinary experts from medical oncology, respiratory medicine, thoracic surgery, radiotherapy, and imaging to conduct an in-depth discussion on the definition and classification of primary resistance and secondary resistance, evaluation criteria of immunotherapy, subsequent treatment strategies of oligo-progression or extensive progression after first-line immunotherapy, re-challenges of immunotherapy and clinical research of new drugs in advanced NSCLC patients with negative driver genes according to the existing evidence. After the consensus meeting, an expert consensus on evaluation and treatment strategy of advanced NSCLC with negative driver genes after first-line immunotherapy resistance was formed, aiming to provide standardized guidance for clinical practice of Chinese clinicians.

To explore the application of modified urethral separation method in artificial urethral sphincter (AUS) implantation in patients with stress urinary incontinence (SUI), and its influence on the results of urethral pressure profilometry.

A prospective collection of clinical data was conducted on 25 patients with stress urinary incontinence who underwent modified urethral separation method in AUS implantation and underwent urethral pressure profilometry in Beijing Hospital, Beijing Jishuitan Hospital Affiliated to Capital Medical University and the Second Hospital Affiliated to Tianjin Medical University from March 2019 to June 2023. The improved urethral separation method was to borrow part of the white membrane tissue of the cavernous body while freeing the dorsal side of the cavernous body of the urethra. The circumference of the urethra, sleeve size, and urethral pressure were recorded, the patient's autonomous urinary control before and after surgery and the changes of the international consultation on incontinence questionnaire-short form (ICI-Q-SF) score, incontinence quality of life questionnaire (I-QoL) score, urinary frequency score, nocturia score were compared. Follow-up was conducted in the clinic or by telephone at 1, 3, 6, and 12 months after activation of the device, and once a year thereafter. Local skin status and urine control were assessed, residual urine volume was measured by ultrasound and subjective score scale was completed.

All patients were male, aged 27-85 (65.8±15.7) years old. The circumference of the cuff used in this study was 4.0 cm in 4 patients (16.0%), 4.5 cm in 16 patients (64.0%), 5.0 cm in 4 patients (16.0%), and 5.5 cm in 1 patient (4.0%). Among them, the urethral circumference matched the cuff size in 14 cases (56.0%), the urethral circumference was smaller than the cuff size in 4 cases (16.0%), and the urethral circumference was larger than the cuff size in 7 cases (28.0%). Preoperative urodynamic examination showed that the maximum urethral pressure (MUP) was (78.0±25.9) cmH₂O, (1 cmH₂O=0.098 kPa) and the maximum urethral closure pressure (MUCP) was (53.4±26.6) cmH₂O. The MUP of AUS device in the inactivated state was (88.0±26.5) cmH₂O, which was not significantly higher than that before operation (P>0.05). The MUCP was (68.2±24.5) cmH₂O, which was significantly higher than that before operation (P<0.05). The MUP and MUCP of the AUS device in the activated state were (146.6±25.2) cmH₂O and (123.0±28.3) cmH₂O, which were significantly higher than those before surgery and in the inactivated state (both P<0.001). All patients in the group reached the social urinary control standards at the first month of device activation. During a follow-up period of 2-50 months, 22 patients (88.0%) used the initial AUS device and all met social urinary control standards. The AUS device was replaced in 1 case. One patient died of cerebrovascular accident. One patient removed the device due to complications. The number of pads [M (Q₁, Q₃)] used in 25 patients before and after operation was 4.5 (3.0, 6.5) and 1 (0, 1) respectively, with statistically significant differences (P<0.001). ICI-Q-SF score, I-QoL score, urinary frequency score and nocturia score of 25 patients were significantly improved after surgery (all P<0.05). The incidence of postoperative complications was 20.0% (5/25), including 2 cases of painless hematuria, 1 case of infection, 1 case of urethral erosion, and 1 case of dysuria. Except for one patient who experienced urethral erosion and had his sleeve removed, the remaining four patients regained social urination control with active support treatment, and no symptoms recurred until the last follow-up.

The modified urethral separation method has no significant effect on urethral pressure in patients with SUI, and can increase the volume of peri-urethral tissue in the cuff, thereby reducing the risk of intraoperative urethral injury and the incidence of postoperative urethral erosion.

To investigate the incidence and influencing factors of hypogammaglobulinemia (HGG) in children with steroid-dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS) treated with rituximab (RTX), and its relationship with the risk of severe infections.

The clinical data of children with SDNS/FRNS treated with RTX at the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University from December 2020 to January 2023 were retrospectively analyzed. RTX treatment was performed using a B-cell-guided regimen (a single dose of 375 mg/m², a maximum of 500 mg/dose, and an additional one dose when reassessment of peripheral blood CD19⁺B cells≥1%). Patients were divided into HGG and non-HGG groups according to the presence or absence of HGG during the follow-up period. A multivariate logistic regression model was used to analyze the influencing factors of HGG, and the predictive value of each influencing factor on HGG was assessed by plotting the receiver operating characteristic (ROC) curve.

A total of 59 SDNS/FRNS children (48 males and 11 females) were included, and aged [M (Q₁, Q₃)] 9.4 (6.5, 12.2) years at the time of the first RTX treatment, with a median application of 3 (2, 4) doses of RTX. During the follow-up period of 15.5 (9.9, 22.8) months, the HGG was present in 16 (27.1%) children, of which seven persisted for more than 1 year. Compared with non-HGG group, HGG group had a shorter duration of the disease [3.3 (2.1, 3.6) vs 4.6 (2.4, 8.0) years, P=0.030], younger age at the time of the first RTX treatment [6.2 (5.6, 7.4) vs 11.3 (8.8, 13.3) years, P<0.001], and lower serum IgG levels [5.9 (4.9, 6.4) vs 7.5 (6.1, 8.2) g/L, P<0.001]. Multivariate logistic regression analysis showed that young age at the time of the first RTX treatment (OR=0.52, 95%CI: 0.35-0.78, P=0.002) was an influencing factor of HGG. The area under the curve (AUC) for age at first RTX treatment to predict HGG was 0.887 (95%CI: 0.778-0.955, P<0.001), with an optimal cut-off value of 8.3 years. During the follow-up period, six children (10.2%) developed severe infectious, and there was no statistically significant difference in the incidence of serious infections between the HGG and non-HGG groups [12.5% (2/16) vs 9.3% (4/43), P=1.000].

HGG is frequent in children with SDNS/FRNS treated with RTX, and nearly half of HGG persists for more than 1 year. The possibility of HGG is greater in those≤8.3 years at the first RTX treatment, but HGG does not increase the risk of severe infections in children.

To analyze the clinical efficacy of intrathyroid thymic carcinoma (ITTC).

This study retrospectively analyzed the clinical data of 21 patients with ITTC diagnosed and treated at the First Affiliated Hospital of Zhengzhou University from January 2018 to July 2023, including 9 males and 12 females, with a median age of 52 years (40-60 years old).

There is a correlation between the maximum diameter of the tumor (≥40 mm) and lymph node metastasis (P=0.044). Seventeen patients received surgical treatment, and 4 patients only received chemotherapy. During the follow-up period, a total of 4 patients experienced death or progression, with a 2-year mortality or progression free survival rate of 74.8%.

The prognosis of ITTC is good, and surgical treatment is the preferred treatment option, lymph node metastasis is significantly correlated with prognosis. The radiotherapy and chemotherapy of ITTC need to be determined based on the patient′s condition.

The data of 115 patients with nasopharyngeal masses (78 males and 37 females) aged between 12 and 78 years at the Sun Yat-sen University Cancer Center from May 2022 to July 2023 were retrospectively reviewed, including 70 cases of nasopharyngeal carcinoma and 45 cases of benign hyperplasia. The mean, median, and percentiles (10^th, 25^th, 75^th, and 90^th) of the apparent diffusion coefficient (ADC) histogram derived from multiplexed sensitivity encoding diffusion-weighted imaging (MUSE-DWI) of the benign hyperplasia group were significantly higher than those of the nasopharyngeal carcinoma group (all P<0.05). Conversely, the kurtosis and skewness of benign hyperplasia group were significantly lower than those of the nasopharyngeal carcinoma group (both P<0.05). The area under receiver operating characteristic (ROC) curve of the combined ADC histogram parameters was 0.812 (95%CI: 0.732-0.892), and the sensitivity, specificity and accuracy were 92.86%, 57.78% and 79.13%, respectively. The current study indicates ADC histogram parameters derived MUSE-DWI exhibit significant discriminatory value between nasopharyngeal carcinoma and benign hyperplasia.

To analyze the clinical features of patients with anterior hypopituitarism (HP) complicated with cirrhosis, and to explore the effects of growth hormone supplementation on liver and lung function. A total of 11 patients with HP complicated with cirrhosis admitted to Peking Union Medical College Hospital from January 2016 to December 2022 were included in the study, including 8 males and 3 females, aged [M(Q₁, Q₃)]31 (20, 37) years. There were 6 patients with pituitary stalk interruption syndrome, 4 patients after craniopharyngioma resection, and 1 patient after germinal cell tumor chemoradiotherapy. Cirrhosis appeared at [M(Q₁, Q₃)]7 (1, 16) years after the diagnosis of HP. There were 7 cases complicated with hepatopulmonary syndrome (HPS). The liver and lung function of 5 patients were improved significantly after the addition of growth hormone, and the arterial partial pressure of oxygen increased from (47±11) mmHg(1 mmHg=0.133 kPa) to (84±12) mmHg. Timely supplementation of growth hormone can improve the symptoms of fatty liver, cirrhosis and HPS, and postpone or even avoid the transplantation of liver and other organs.

This article reports the imaging findings of a case of lupus mastitis. A 38-year-old female was diagnosed with "systemic lupus erythematosus" more than 20 years ago. In 2014, the patient developed flaky erythema on the skin of the left breast without obvious trigger, accompanied by skin ulcer, and a dark red rash remained on the skin of the left breast after treatment. April 2022 mammography showed left breast atrophy with dystrophic calcification, thickened skin, and swollen axillary lymph nodes; Breast MRI revealed an uneven enhanced mass; Pathology of puncture specimen of left breast mass suggests lupus mastitis. The imaging features of lupus mastitis have certain characteristics, especially in the chronic stage of lupus mastitis. An accurate analysis of its clinical and imaging features can avoid unnecessary surgery or tissue biopsy injury.

A 76-year-old patient with lymphoma experienced repeated syncope after chemotherapy was reported. Combined with the history of syncope attacks and related examination results, it was considered that the syncope of the patient was probably caused by the enlarged lymph nodes in the neck compressing the carotid sinus. However, further improvement of dynamic electrocardiogram showed that the sinus node dysfunction was found. After installation of temporary pacemaker and local radiotherapy of nasopharyngeal and cervical lymph nodes, the patient's cervical lymph node lesions were smaller than before, and there was no recurrent syncope.

No cases of Hodgkin's lymphoma (HL) occurring in the lower common bile duct have been reported. The clinical manifestations, laboratory tests and imaging tests of lower common bile duct HL lack specificity, and the differential diagnosis from lower common bile duct cancer is difficult. Zhejiang Provincial People's Hospital admitted a patient with primary lower common bile duct HL on December 2, 2020. The diagnosis and treatment process and experience are summarized as follows.

Patients in intensive care units often experience fluid overload. Multiple studies have shown that fluid overload is associated with adverse outcomes. Therefore, managing and optimizing fluid balance becomes one of the core tasks of critically ill patient management. Excess volume removal using continuous renal replacement therapy is associated with improved prognosis in critically ill patients with acute kidney injury. Achieving successful volume management requires mastery of basic pathophysiological knowledge, accurate assessment of volume status, and setting reasonable treatment goals. This article reviews the volume status and volume management strategies of critically ill patients, the volume management principles of continuous renal replacement therapy, the goals and strategies of fluid balance, and the goals and strategies of net ultrafiltration rate, aiming to provide guidance for volume management of critically ill patients undergoing continuous renal replacement therapy.

Recurrent miscarriage is when a woman has two or more consecutive spontaneous miscarriages with the same sexual partner. The vaginal microbiome refers to the microbial community present in the vagina, including bacteria, fungi, and viruses, among others. Past studies have shown that an imbalance in the vaginal microbiome may be associated with pregnancy complications and adverse pregnancy outcomes. Therefore, understanding the characteristics of the vaginal microbiome in patients with recurrent miscarriage is of great significance for revealing its etiology and finding potential treatments.

In 2020, the World Health Organization (WHO) recognized the standard molecular typing of endometrial cancer (EC), including POLE hypermutant (POLE mut), mismatch repair deficient (MMRd), p53 mutant (p53 abn) and non-specific molecular profiling (NSMP), and emphasized the importance and convenience of p53 immunohistochemistry (IHC) methods to distinguish p53 abn from NSMP. Abnormal p53 IHC staining patterns including "overexpression", "complete deletion" and "cytoplasmic expression" of p53 in tumor cells. Specific regions within the tumor showed aberrant p53 IHC staining, while the remaining tumors showed wild-type p53 expression, known as a "subclonal" pattern of aberrant p53 expression, in which sequencing analysis did not always identify TP53 mutations in tumors of this pattern.

The International Union of Obstetrics and Gynecology (FIGO) has combined molecular typing in 2023 Endometrial Cancer Staging, highlighting the significance of molecular typing for the diagnosis, treatment and prognostic value of endometrial cancer (EC). There are data showing that about 20% of newly diagnosed cases of EC occur in premenopausal women, and surgical treatment may pose a potential risk to fertility in these patients. Predicting the responsiveness and subsequent recurrence of EC or endometrial dysplasia (AEH) to progesterone by pathological and clinical factors is an area of current interest.